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. 2024 Jan 11:14:1278233.
doi: 10.3389/fpsyt.2023.1278233. eCollection 2023.

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study

Celica Glenn Cosme  1 , Nathan O Rudig  2 , Philip J Borsellino  1 , Deanna Chea  1 , Reese I Krider  1 , Lisa Durette  1
Affiliations

Prescribed psychotropic medication patterns among treated Foster Care enrollees: a single institution study

Celica Glenn Cosme et al. Front Psychiatry. .

Abstract

Background: While several state-based studies have shown that children in foster care are more likely to be prescribed psychotropic medications and experience concomitant medication use both within and among medication class, these patterns have not been explored in the state of Nevada, which lacks state mandated oversight of psychotropic prescribing for foster care enrolled youth.

Methods: Data from an electronic medical record system from a single institution were analyzed to examine the prevalence of psychotropic prescribing and concomitant medication use in children ages 2 to 19 who were enrolled and received psychotropic prescriptions between July 2019 to June 2022.

Results: Out of 569 distinct psychotropic medication treatment episodes within this cohort, the most frequent psychotropic classes prescribed were non-stimulant ADHD medications (alpha-agonists and atomoxetine, 31.5%), atypical antipsychotics (22.1%), antidepressants (20.6%), and stimulants (16.0%). The use of stimulants and non-stimulant ADHD medications decreased in older age groups while the use of antidepressants and antipsychotics increased in older age groups. During the three-year period studied, 24.0% of psychotropic medications prescriptions increased in dosage. Treatments were prescribed for only one month in 43.8% of youth. In children prescribed psychotropic medications, concomitant medication use for at least 60 days occurred in 28.0% of children who had any psychotropic medication prescribed.

Conclusion: Within the cohort of 273 foster care enrolled subjects aged 2 to 19 years old who received psychotropic medication prescriptions, non-stimulant ADHD medications (both alpha-agonists and atomoxetine) and atypical antipsychotics were more commonly co-prescribed additional psychotropic medication compared to other co-prescribed medication categories. This study illustrates prescribing patterns in a community mental health clinic focused on judicious prescribing of psychotropic medications in foster care enrolled youth. Despite this, 41% of the youth treated in this clinic received at least one prescription for psychotropic medication, and of those, 27.8% were prescribed more than one psychotropic medication at the same time. More studies are necessary to understand the underlying causes of high prevalence of concomitant medication use and prescribing practices of psychotropic medications use in foster care involved pediatric populations.

Keywords: desprescribing; foster care; medicaid; polypharmacy; psychotropic medications.

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Conflict of interest statement

LD is one of the original founders of the clinic included in this analysis. She joined full-time faculty of the Kirk Kerkorian School of Medicine at UNLV in May 2020. She has not worked in the clinic since 2016. Nathan Rudig is a current employee of the clinic included in this analysis. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Prescribed psychotropic medication classes by age group. Psychotropic medication prescribing trends by age group between 2019 to 2022. The figure displays the percentage of children prescribed a major medication class by age group in relation to the total number of subjects in the age group.
Figure 2
Figure 2
60-day overlapping concomitant class use (2–6 classes) among prescribed psychotropic by age group. Polypharmacy was defined as having two or more psychotropic medications with 60-day concurrent use.
See this image and copyright information in PMC

References

    1. Olfson M, Blanco C, Wang S, Laje G, Correll CU. National trends in the mental health care of children, adolescents, and adults by office-based physicians. JAMA Psychiatry. (2014) 71:81–90. doi: 10.1001/jamapsychiatry.2013.3074, PMID: - DOI - PubMed
    1. Rubin D, Matone M, Huang YS, DosReis S, Feudtner C, Localio R. Interstate variation in trends of psychotropic medication use among Medicaid-enrolled children in foster care. Child Youth Serv Rev. (2012) 34:1492–9. doi: 10.1016/j.childyouth.2012.04.006 - DOI
    1. Stambaugh LF, Leslie LK, Ringeisen H, Smith K, Hodgkin D. Psychotropic medication use by children in child welfare. OPRE Report #2012-33. Washington, DC: Office of Planning, Research and Evaluation, Administration for Children and Families, U.S. Department of Health and Human Services. (2012):1–9.
    1. Fernandes-alcantara AL, Caldwell SW, Stoltzfus E. Child welfare: oversight of psychotropic medication for children in Foster Care. Congressional Res Service Report. (2017):1–37.
    1. Keefe RJ, Cummings ADL, Greeley CS, Van Horne BS. Mental health and developmental disorder diagnoses of Foster and Nonfoster children enrolled in Medicaid. J Dev Behav Pediatr. (2022) 43:e296–303. doi: 10.1097/DBP.0000000000001030, PMID: - DOI - PubMed

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